ABSTRACT
The biological system of the oral cavity provides a number of protective mechanisms that fight pathogenic factors that arise due to a decrease in local immunity. This problem is found in patients after Covid-19. There is a violation of the blood supply to all organs and systems, including the mucous membrane of the oral cavity. As a result, patients have an increased risk of ulcers, plaques, fungal infections of the oral cavity, cracks, and spot hemorrhages. Due to a decrease in immune reactions in the oral cavity, the risk of caries in all groups of teeth increases, the permeability of enamel increases, and mineral substances exit from the hard tissues of the tooth.
ABSTRACT
The immune system is comprised of lymph glands, lymph nodes, thymus gland, spleen, bone marrow, lymphocytes, and molecules such as antibodies and cytokines. It has a vast array of functionally different cells such as T and B lymphocytes, macrophages, neutrophils and mast cells. The ontogenesis of the immune system is comprised of the innate immune cells and the adaptive immune cells, where innate immune cells are the first defense mechanisms to respond to pathogenic environmental factors. There are multiple components of the adaptive immune cells, including immunoglobulins (Igs), T-cell receptors (TCR), and major histocompatibility complex (MHC) responsible for adaptive immunity. However, many elements of both the innate and adaptive immune systems are conserved in our bodies. The adaptive immunity is a type of immunity that develops when a person’s immune cells respond to a pathogen such as microorganism or vaccination. Environmental factors such as pathogenic bacteria or viruses, solar exposure, age, exercise, stress, diet, sleep quality and air pollutants can influence the immune system. There may be marked decline in the immune function due to attack of COVID-19. Most patients with mild COVID-19 develop an appropriate immune response that culminates with viral clearance. However, severe disease manifestations have been linked to lymphopenia and immune hyper-responsiveness leading to cytokine storm. It has been observed that in COVID-19, alveolar macrophages are epigenetically altered after inflammation, leading to long-term lung immune-paralysis. Western diets are known to have adverse effects on the immune function. However, Mediterranean-type diets rich in short-and long-chain polyunsaturated fatty acids (PUFA), vegetables, nuts and fruits, dairy products and fish and red wine, due to high content of vitamins, minerals and flavonoids may be useful in boosting immunity. Moderate physical activity may also cause an extensive increase in numerous and varied lipid super-pathway metabolites, including oxidized derivatives called oxylipins. Emerging evidence suggests that dietary supplements containing flavonoids, carotenoids, coenzyme Q10 (CoQ10), vitamins, minerals and antioxidants modulate gene and protein expression and thereby modify endogenous metabolic pathways, and consequently enhance the immunity. Mediterranean-type diet and multiple bioactive nutrients, fatty acids, amino acids, vitamins and minerals as well as moderate physical activity may be crucial for enhancing immunomodulation.
ABSTRACT
The developed HoloDoctor software package allows performing surgical operations in real time. It should be emphasized that the operation time on the HoloDoctor PC is reduced by 20-30% compared to traditional methods. The performance of HoloLens glasses with our program is high, while allowing the doctor to save time. The complex provides diagnostics, therapy planning, treatment adjustment as needed and minimizes the risk of medical error. HoloDoctor can be used in educational practice by integrating it into educational programs for medical specialties.
ABSTRACT
Background: High-grade B-cell lymphoma double-hit (HGBL DH) can arise from follicular lymphoma (FL). In the case of transformation of FL it accumulates a large number of additional mutations and secondary c-MYC gene rearrangement, which can make it resistant to standard immunochemotherapy. Aims: To evaluate an efficacy of induction regimen R-CHOP/R-DAEPOCH and modified BFM chemotherapy with rituximab in treatment of HGBL DH raised from FL. Methods: We studied13 FL pts with double- (9 - with c-MYC/8q24 and BCL2/18q21;4 - with c-MYC/8q24 and BCL6/3q27) and one pt with triple translocations involving c-MYC/8q24, BCL2/18q21 and BCL6/3q27 genes and deletion of17p13.10 pts had morphological signs of transformation into aggressive lymphoma;4 pts had FL 3A. There was 8 women and 6 men aged from 30 to 60 y. o. (median 47 y.o.). Lymph node with the highest FDG-accumulation according to PET-CT was chosen for biopsy and consequent immunohistochemistry and cytogenetics. The majority of pts had high12/14 and 2/14 - high-intermediate FLIPI score. All pts had advanced (III-IV) stage according to Ann-Arbor classification. 3 out of14 pt had a history of low-grade FL (16-96 months) without c-MYC rearrangement in primary biopsy samples, in other11 cases - anamnesis varied from 0,5 to 4,0 months. Lymphoma manifested by rapidly spread aggressive tumor with bulky disease: 2 pts had leukemic presentation of FL;1 pt had FL cells in cerebrospinal fluid;12/14 out of pts had several extranodal sites of involvement such as ovaries (2/8), kidneys or adrenals (6/14), paranasal sinuses (1/14);bones (3/14);soft tissues (4/14);lungs (3/14);stomach or intestine (4/14);spleen (4/14);liver (1/14). Ki-67 varied from 40 to 90%. An expression of c-MYC protein higher than 40% in11/13 of FL pts. We didn't revealed TP53 mutation within 7 out of 7 analyzed pts. Results: None of pts had previous therapy. 4 pts were treated with R-CHOP-21. 3/4 (75%) out of pts died due to progressive disease (PD),1/4 (25%) had partial remission (PR) after consequent therapy including obinutuzumab. 7 pts underwent modified BFM-protocol with Rituximab. 6/7 (86%) out of pts achieved complete remission (CR) after first-line treatment,1 pt died due COVID-19 in PD status (14%). Autologous stem cell transplantation (auto-SCT) was performed in 4 out of 7 pts. 3 pts underwent R-DA-EPOCH.1 pt achieved a CR after 6 courses,1 pt - after second-line 2 R-DHAP;auto-SCT was performed for consolidation.1 pt (33%) had PD after R-DA-EPOCH and another therapy. Rituximab supportive treatment was administrated only in 4 cases due to epidemiological situation. Median of observation was 9 months (1,0-59,5). We couldn't study TP53 mutation status in pts with PD, but we observed PD in one case with deletion of17p13. Summary/Conclusion: For better diagnostics of FL transformation into HGBL DH we should perform biopsy of lymph node with the most active FDG accumulation according to PET-CT. We observed a higher rate of CR in this pts cohort when treated with intensive induction immunochemotherapy (modified BFM chemotherapy with rituximab) in comparison with R-CHOP/R-DA-EPOCH (86% vs 25% and 33%, respectively), and lower rate of primary resistance/PD (14% vs 75% and 33%). Our data needs consequent confirmation or consideration within metanalysis due to rare diagnostics of FL with double translocations of c-MYC and BCL2/BCL6. We should initiate a randomized study to estimate if auto-SCT had any benefits in comparison with a new immunotherapy modalities in FL transformed into HGBL DH.